Using Technology to Promote Participant Centered Services: A Collaboration between the Oregon and Arizona WIC Programs

1. Using Technology to Promote Participant Centered Services: A Collaboration between the Oregon and Arizona WIC Programs

3. Value Enhanced Nutrition Assessment (VENA) Recommendation: All women and children ages 2 to 5 years should be presumed to be at dietary risk based on failure to meet the Dietary Guidelines for Americans. Goal: to expand the purpose of nutrition assessment from eligibility determination to improved nutrition education. VENA will improve and enhance the risk assessment process by ensuring that a medical-nutritional assessment continues to be completed and streamlining dietary assessment to collect more relevant information to be used to individualize nutrition services. VENA represents a paradigm shift in that VENA will change the way that WIC interacts with applicants, participants and program staff. Participant risks and needs change over time, as do the scientific knowledge and best practices for methods to improve the health of women, infants and children. VENA allows and encourages the adaptation and enhancement of the program to address new emerging health-related risks and the changing needs of participants By 10/2009VENA will improve and enhance the risk assessment process by ensuring that a medical-nutritional assessment continues to be completed and streamlining dietary assessment to collect more relevant information to be used to individualize nutrition services. VENA represents a paradigm shift in that VENA will change the way that WIC interacts with applicants, participants and program staff. Participant risks and needs change over time, as do the scientific knowledge and best practices for methods to improve the health of women, infants and children. VENA allows and encourages the adaptation and enhancement of the program to address new emerging health-related risks and the changing needs of participants By 10/2009

4. Definition of Participant Centered Education Participant centered education (PCE) focuses on people�s capacities, strengths and developmental needs � not solely on their problems, risks, or negative behaviors. Currently a participant comes to our clinic, we determine risk, then tell them what they need to do in order to get better or resolve the risk. After 30 plus years of effort and research, we know that the old way doesn�t work. Oregon WIC Listens is about a new way to try to improve our participant�s health outcomes. We call it �Participant Centered Counseling�. This new way focuses on helping the participant to identify what are their concerns and strategies needed to make the changes they want to make. When we are talking about how this applies to the whole clinic, we call it participant centered services (PCS). One national group has defined it as a comparison of teacher versus learner centered education. The benefit to the certifier is that this new process is a really positive one and it takes the responsibility for changing behaviors from you. Currently a participant comes to our clinic, we determine risk, then tell them what they need to do in order to get better or resolve the risk. After 30 plus years of effort and research, we know that the old way doesn�t work. Oregon WIC Listens is about a new way to try to improve our participant�s health outcomes. We call it �Participant Centered Counseling�. This new way focuses on helping the participant to identify what are their concerns and strategies needed to make the changes they want to make. When we are talking about how this applies to the whole clinic, we call it participant centered services (PCS). One national group has defined it as a comparison of teacher versus learner centered education. The benefit to the certifier is that this new process is a really positive one and it takes the responsibility for changing behaviors from you.

5. The Spirit of PCE Genuinely warm and respectful, both sides bring something to the table Accepting and understanding, even if you don�t agree Individualized and emphasizes freedom of choice Collaborative � walk side by side, rather than one pushing or pulling the other Dancing vs. wrestling Participant Does most of the talking Determines what is most important to them Identifies their own ideas for change Counselor/Certifier Elicits motivation from the participant Is directive (not persuasive) Acknowledges participant readiness Is a partner Participant Does most of the talking Determines what is most important to them Identifies their own ideas for change Counselor/Certifier Elicits motivation from the participant Is directive (not persuasive) Acknowledges participant readiness Is a partner

6. The Spirit of PCE

7. Active Listening Skills Open-ended questions Affirming Reflecting Summarizing

8. Giving Advice �I have found that the best way to give advice is to ask the person what they would like to do and then advise them to do it.� ~ Harry Truman Once you have identified the top issues on your circle chart. This next phase for a CPA is to provide Nutrition Education. You might think of it as counseling or giving advice. In participant centered counseling you will use those same active listening skills you used during the assessment to find out what the participant already knows about the issue they have identified and what they have tried or are willing to try. This is a balance between asking enough questions to help them find their own answers and offering information from our expertise Remember, we are most convinced by what we hear ourselves say, so whenever we can get them to say what they will do, we are going to be more successful. By doing this, you let go of responsibility for participant behavior change (36). You no longer have to wrestle them into doing something. Instead you will be dancing with them as a partner.Once you have identified the top issues on your circle chart. This next phase for a CPA is to provide Nutrition Education. You might think of it as counseling or giving advice. In participant centered counseling you will use those same active listening skills you used during the assessment to find out what the participant already knows about the issue they have identified and what they have tried or are willing to try. This is a balance between asking enough questions to help them find their own answers and offering information from our expertise Remember, we are most convinced by what we hear ourselves say, so whenever we can get them to say what they will do, we are going to be more successful. By doing this, you let go of responsibility for participant behavior change (36). You no longer have to wrestle them into doing something. Instead you will be dancing with them as a partner.

9. PCE Training: 9 Month �Gestation� Champion Training � 1 day Certifier Training � 2 half days 4 champion conference calls � every other month 4 on-site visits � every other month Meet with all staff for debrief Meet with champions separately Observations of certifiers with immediate, supportive feedback Handout: Oregon WIC Listens � Training and Support Champion Training: Basic training on 4 roles of Champion-- Catalyst for change (planning ways to help people start making changes) Keeping the spirit alive (Buzz, encouragement, support) Providing positive feedback and support for peer-to-peer observations Facilitating opportunities for growth (formal and informal sharing, continuing education, staff discussions, logistics) Certifier Training: For all certifiers in cohort (Nurses included, but not included in observations) Champion Conference Calls: Begin after Certifier Training�Check-in to see how things are progressing (includes all champions from cohort) Onsite Visits: use sub-bullets for talking points CEs Handout: Oregon WIC Listens � Training and Support Champion Training: Basic training on 4 roles of Champion-- Catalyst for change (planning ways to help people start making changes) Keeping the spirit alive (Buzz, encouragement, support) Providing positive feedback and support for peer-to-peer observations Facilitating opportunities for growth (formal and informal sharing, continuing education, staff discussions, logistics) Certifier Training: For all certifiers in cohort (Nurses included, but not included in observations) Champion Conference Calls: Begin after Certifier Training�Check-in to see how things are progressing (includes all champions from cohort) Onsite Visits: use sub-bullets for talking points CEs

10. Statewide Training

11. Western Region Collaboration Summer of 2003: Western Region WIC Nutrition Coordinators met to identify possible collaborative projects where states could pool USDA Operational Adjustment (OA) funds and centralize project management to benefit all of the states and ITOs in the region.� Arizona requested and received OA funds to create an on-line training module and subsequently partnered with Oregon to utilize the curriculum they had developed. The goal of this project was to support the implementation of Participant Centered Education (PCE) methods into WIC services of the Western Region States. Many State Agencies had invested in training local agency staff to utilize PCE methods; however the investment needed to adequately train WIC staff in these methods is too much for any one State Agency to afford. In response, each State Agency in the Western Region agreed that $120,000 funds would be set aside for this project and a lead State agency (Arizona) was designated as the financial lead of the project. To train staff in providing participant centered education (PCE), Oregon WIC is collaborating with Arizona WIC to design and produce a new kind of interactive, multi-media, online training module. The goal of this project was to support the implementation of Participant Centered Education (PCE) methods into WIC services of the Western Region States. Many State Agencies had invested in training local agency staff to utilize PCE methods; however the investment needed to adequately train WIC staff in these methods is too much for any one State Agency to afford. In response, each State Agency in the Western Region agreed that $120,000 funds would be set aside for this project and a lead State agency (Arizona) was designated as the financial lead of the project. To train staff in providing participant centered education (PCE), Oregon WIC is collaborating with Arizona WIC to design and produce a new kind of interactive, multi-media, online training module.

12. Nine PCE Modules What Motivates People to Change? The Spirit of PCE Opening the Conversation O.A.R.S. Roadblocks to Listening Moving from Assessment to Counseling Providing Advice: Offering Nutrition Education Rolling with Resistance Next Steps

13. Blended Format eLearning modules � Multi-media modules that help to explain and demonstrate PCE skills. Practice activities � At the end of each eLearning module, the learner will download an activity that helps apply what they�ve just learned � on the job! De-briefing � The learner will meet with their supervisor to discuss what they�ve learned. This module is designed to train new staff and to provide continued support to existing staff as they hone their participant centered skills. State and local agencies nationwide will be able to use this online module to support acquisition of participant centered skills. This module is designed to train new staff and to provide continued support to existing staff as they hone their participant centered skills. State and local agencies nationwide will be able to use this online module to support acquisition of participant centered skills.

14. Content Review Content of the modules was reviewed by the following states: Alaska, Arizona, California, Guam, Oregon, and Washington. Content of the modules was reviewed by the following states: Alaska, Arizona, California, Guam, Oregon, and Washington.

16. Sample Screenshot

18. Nutrition Edutainment Explore: Ask what she already knows, has heard of, or would like to know.

19. Beta Version of the Modules http://www.cinelp.com/wic-listens/beta/modintro/ http://www.cinelp.com/wic-listens/beta/mod1/ http://www.cinelp.com/wic-listens/beta/mod2/ http://www.cinelp.com/wic-listens/beta/mod3 http://www.cinelp.com/wic-listens/beta/mod4/ http://www.cinelp.com/wic-listens/beta/mod5/ http://www.cinelp.com/wic-listens/beta/mod6/ http://www.cinelp.com/wic-listens/beta/mod7/ http://www.cinelp.com/wic-listens/beta/mod8/ http://www.cinelp.com/wic-listens/beta/mod9/

20. How WIC Staff Feel About PCE �Participant centered counseling has made my job more enjoyable. The client feels comfortable and respected from the very beginning of the visit which leads to a much more productive time for both of us. I love being able to hear what client's already know and what they are interested in.� ~ Local WIC staffer PP - quote from local agency. Let go of our responsibility for participant making a behavior change Let go of our �expert� role � they are the experts in their own livesPP - quote from local agency. Let go of our responsibility for participant making a behavior change Let go of our �expert� role � they are the experts in their own lives

21. Local Agencies are Listening! Tory Sutherland-Palenske and Yami Garcia from Clatsop County celebrate completion of their pilot cohort. Tory Sutherland-Palenske and Yami Garcia from Clatsop County celebrate completion of their pilot cohort.

22. Thank you for listening� what questions do you have?